A prospective, randomized, controlled trial of 2-octylcyanoacrylate versus suture repair for nail bed injuries.

PURPOSE: To prospectively compare the efficacy of 2-octylcyanoacrylate (Dermabond; Ethicon Inc, Somerville, NJ) with standard suture repair in the management of nail bed lacerations. METHODS: Forty consecutive patients with acute nail bed lacerations were enrolled in this study. Eighteen patients were randomized to nail bed repair using Dermabond (2-octylcyanoacrylate), and 22 were randomized to standard repair using 6-0 chromic suture. At presentation, demographic information and laceration characteristics were recorded. The time required for nail bed laceration repair with each method was documented, and cosmetic and functional outcomes were assessed at 1, 3, and 6 months after injury. Comparisons between treatment groups were made using unpaired Student's t-tests. RESULTS: The Dermabond repair group was composed of 10 males and 8 females with a mean age of 32.3 years. The suture repair group was composed of 17 males and 5 females with a mean age of 29.5 years. The mean follow-up was 5.1 months (range 4-11 months) and 4.8 months (range 4-11 months) for the Dermabond group and suture group, respectively. There was no difference between the two treatment groups with respect to age, comorbidities, and length of follow-up (p>.05). The average time required for nail bed repair using Dermabond was 9.5 minutes, which was significantly less than that required for suture repair (27.8 minutes) (p<.0003). At each follow-up time point, there was no statistical difference in physician-judged cosmesis, patient-perceived cosmetic outcome, pain, or functional ability between the Dermabond and suture treatment cohorts (p>.05). CONCLUSIONS: Nail bed repair performed using Dermabond is significantly faster than suture repair, and it provides similar cosmetic and functional results. In the management of acute nail bed lacerations, Dermabond is an efficient and effective repair technique. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.

High-altitude illness and muscle physiology.

High-altitude illness is a growing concern in sports medicine that affects persons shortly after they have climbed to a new high-altitude level to which their body is not acclimatized. With the increasing popularity of extreme sports, such as high-altitude mountaineering, skiing, and snowboarding, the incidence of complications arising from sports activities at high altitudes is increasing. High-altitude pulmonary edema and high-altitude cerebral edema are potentially fatal conditions. The study of high-altitude muscle physiology has broad ramifications in creating training programs for elite endurance athletes. A thorough understanding of the pathophysiology, presentation, treatment, and prevention of high-altitude illness is necessary for the treatment of these patients.

A biomechanic comparison of an internal radiocarpal-spanning 2.4-mm locking plate and external fixation in a model of distal radius fractures.

PURPOSE: To compare the biomechanic stability of distal radius fracture fixation with a new internal radiocarpal-spanning 2.4-mm locking plate, which acts as an internal distal radius fixator, versus a standard distal radius external fixator. The number of locking screws necessary for adequate fracture fixation was also assessed. METHODS: Ten cadaveric specimens were mounted in a loading fixture with cables attached to the 2 flexor and 3 extensor wrist tendons. A 1-cm osteotomy was created to simulate an unstable distal radius fracture. The radiocarpal-spanning locking plate was fixed to the radius and index metacarpal with 4 screws proximally and 4 distally. The specimen was incrementally loaded through the tendons. Motion at the fracture site was determined. Screws were sequentially removed from the construct, the specimen was again incrementally loaded, and fracture motion was measured. The fixation was then changed to an external fixator, and the loading tests were repeated. RESULTS: Fracture fixation with the radiocarpal-spanning 2.4-mm locking plate was significantly more stable with 4 screws proximally and 4 screws distally (4 x 4) and with the 3 x 3 configuration than with the external fixator in both flexion and extension. The 4 x 4 screw configuration was not significantly different from the 3 x 3 screw configuration. The 4 x 4 screw configuration was significantly more stable than the 2 x 2 and 1 x 1 screw configurations in both flexion and extension. All internal fixator configurations and the external fixator showed more fracture displacement at increasingly higher loads. CONCLUSIONS: Fracture fixation with the new internal radiocarpal-spanning 2.4-mm locking plate is more stable than with a standard distal radius external fixator. Only three 2.4-mm locking screws proximally and three 2.4-mm locking screws distally are required for adequate fixation of the locking spanning plate.

Open and arthroscopic treatment of perilunate injuries.

UNLABELLED: Carpal dislocations are rare and complex injuries. Nearly every combination of radiocarpal and intercarpal dislocation has been described, but few fit neatly into a particular pattern or classification scheme. The injury may be subtle clinically and radiographically, and the diagnosis is frequently delayed. Prompt recognition, accurate reduction, and stable temporary internal fixation all contribute to improved outcomes. Internal fixation techniques depend on the pathology imparted on the carpus. Open reduction, arthroscopic, and fluoroscopically aided percutaneous techniques can be used to successfully treat carpal dislocations. We report our experiences treating perilunate injuries. LEVEL OF EVIDENCE: Level V (expert opinion).

Bridge plating of distal radius fractures: the Harborview method.

UNLABELLED: High-energy comminuted distal radius fractures treated at Level 1 trauma centers represent unique treatment challenges. In particular, two groups of patients require special consideration: patients with high-energy injuries that have fracture extension into the radius and ulna diaphysis and patients with multiple injuries that require load bearing through the injured wrist to assist with mobilization. We report our experiences treating these injuries with a bridge plating technique. The bridge plate acts as an "internal fixator" and depends on ligamentotaxis for fracture reduction. The technique has been found to be performed easily and achieves the goals of maintenance of fracture reduction, allows weightbearing through the injured extremity, and is associated with few complications. We describe the technique and review our experience with a retrospective chart review of 62 consecutive patients. LEVEL OF EVIDENCE: Therapeutic study, level IV (case series).

Treatment of distal radius fractures with intrafocal (kapandji) pinning and supplemental skeletal stabilization.

The technique of intrafocal pinning was originally described by Kapandji. This technique, along with the addition of supplemental external or internal bridging fixation, can be performed quickly with minimal soft tissue damage. This technique is indicated for the treatment of unstable extra-articular or minimally displaced intra-articular fractures of the distal radius. Studies demonstrate that young patients with displaced extra-articular distal radius fractures and minimal comminution can be treated by percutaneous intrafocal pin fixation alone, whereas, patients over 55 years of age and younger patients with comminution involving two or more surfaces of the radial metaphysis (or > 50% of the metaphyseal diameter) require bridging fixation besides percutaneous pin fixation. The use of this technique achieves the goal of surgical treatment of distal radius fractures: restoration of hand and wrist function through the restoration of alignment and articular surface congruity.